6,377 results match your criteria Canadian journal of surgery. Journal canadien de chirurgie[Journal]


Opioid use trends in patients undergoing elective thoracic and lumbar spine surgery.

Can J Surg 2020 May 28;63(3):E306-E312. Epub 2020 May 28.

From the Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ont. (Stratton, Wai, Kingwell, Phan); The Ottawa Hospital Research Institute, Ottawa, Ont. (Roffey, El Koussy); the Division of Neurosurgery, Dalhousie University, Halifax, N.S. (Christie); the Department of Surgery, McGill Scoliosis & Spine Group, McGill University, Montreal, Que. (Jarzem); Victoria Hospital, London Health Sciences Centre, London, Ont. (Rasoulinejad); the Foothills Medical Centre, University of Calgary, Calgary, Alta. (Casha, Thomas); Université Laval, Québec, Que. (Paquet); the Winnipeg Spine Program, Health Sciences Centre, Winnipeg, Man. (Johnson); the Canada East Spine Centre, Saint John Regional Hospital, Saint John, N.B. (Abraham, Manson); the Department of Surgery, University of Toronto, Toronto, Ont. (Hall); Canadian Spine Outcomes and Research Network, Toronto, Ont.(McIntosh); Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont. (Rampersaud); and the Combined Neurosurgery and Orthopaedic Spine Program, University of British Columbia, Vancouver, B.C. (Fisher).

Background: Opioid use in North America has increased rapidly in recent years. Preoperative opioid use is associated with several negative outcomes. Our objectives were to assess patterns of opioid use over time in Canadian patients who undergo spine surgery and to determine the effect of spine surgery on 1-year postoperative opioid use. Read More

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http://dx.doi.org/10.1503/cjs.018218DOI Listing

Operating during COVID-19: Is there a risk of viral transmission from surgical smoke during surgery?

Can J Surg 2020 05 25;63(3):E299-E301. Epub 2020 May 25.

From the Department of General Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.

Summary: The World Health Organization declared a pandemic when coronavirus disease 2019 (COVID-19) started to sweep the globe. Growing concerns for the safety of health care workers was raised when up to 80% of people with COVID-19 showed mild or no symptoms at all. Some surgical procedures will be inevitable during the pandemic, and proper safety measures must be in place to avoid transmission risks. Read More

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http://dx.doi.org/10.1503/cjs.007020DOI Listing

Prioritizing resident and patient safety while maintaining educational value: emergency restructuring of a Canadian surgical residency program during COVID19.

Can J Surg 2020 May 25;63(3):E302-E305. Epub 2020 May 25.

From the Division of General Surgery, Department of Surgery, Faculty of Medicine, University of Ottawa, Ottawa, Ont.

Summary: Surgical programs are facing major and fluctuating changes to the resident workforce because of decreased elective volumes and high exposure risk during the coronavirus disease 2019 pandemic. Rapid restructuring of a residency program to protect its workforce while maintaining educational value is imperative. We describe the experience of the Division of General Surgery at the University of Ottawa in Ontario, Canada. Read More

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http://dx.doi.org/10.1503/cjs.006120DOI Listing

Sustainability of an Enhanced Recovery After Surgery initiative for elective colorectal resections in a community hospital.

Can J Surg 2020 May 21;63(3):E292-E298. Epub 2020 May 21.

From the Clinical Epidemiology Unit, Memorial University of Newfoundland, St. John's, Nfld. (Norman, Mahoney, Parfrey); Eastern Health, St. John's, Nfld. (Ballah); the Discipline of Anesthesia, Memorial University of Newfoundland, St. John's, Nfld. (Pridham); and the Discipline of Surgery, Memorial University of Newfoundland, St. John's, Nfld. (Smith).

Background: In March 2016, an Enhanced Recovery After Surgery (ERAS) initiative was implemented for all elective colorectal resections at an urban hospital in St. John's, Newfoundland and Labrador, Canada. An ERAS coordinator supervised and enforced guideline compliance for 6 months. Read More

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http://dx.doi.org/10.1503/cjs.016018DOI Listing

Surgeon clinical practice variation and patient preferences during the informed consent discussion: a mixed-methods analysis in lumbar spine surgery.

Can J Surg 2020 May 21;63(3):E284-E291. Epub 2020 May 21.

From the Division of Orthopaedic Surgery, University of Toronto, Toronto, Ont.

Background: Patients with lumbar disc herniation may greatly benefit from microdiscectomy. Although spine surgeons performing microdiscectomy routinely obtain informed consent, the potential adverse events they disclose often vary. Moreover, little is known about what disclosures are deemed most valuable by patients. Read More

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http://dx.doi.org/10.1503/cjs.005619DOI Listing

Waste and recycling among orthopedic subspecialties.

Can J Surg 2020 May 21;63(3):E278-E283. Epub 2020 May 21.

From the Section of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (Kooner, Hewison, Sridharan, Clark); the Section of Otolaryngology-Head and Neck Surgery, University of Calgary, Calgary, Alta. (Lui); the Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, Man. (Matthewson); and the Division of Orthopaedic Surgery, McMaster University, Hamilton, Ont. (Johal).

Background: It is estimated that one-quarter to half of all hospital waste is produced in the operating room. Recycling of surgical waste in the perioperative setting is uncommon, even though there are many recyclable materials. The objective of this study was to determine the amount of waste produced in the preoperative and operative periods for several orthopedic subspecialties and to assess how much of this waste was recycled. Read More

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http://dx.doi.org/10.1503/cjs.018018DOI Listing

Visceral artery pseudoaneurysm in necrotizing pancreatitis: incidence and outcomes.

Can J Surg 2020 May 21;63(3):E272-E277. Epub 2020 May 21.

From the Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana (Maatman, Roch, House, Nakeed, Ceppa, Schmidt, Zyromski); the Indiana University School of Medicine, Indianapolis, Indiana (Heimberger, Lewellen); and the Center for Outcomes Research in Surgery (CORES), Indiana University School of Medicine, Indianapolis, Indiana (Colgate).

Background: Visceral artery pseudoaneurysms (VA-PSA) occur in necrotizing pancreatitis; however, little is known about their natural history. This study sought to evaluate the incidence and outcomes of VA-PSA in a large cohort of patients with necrotizing pancreatitis.

Methods: Data for patients with necrotizing pancreatitis who were treated between 2005 and 2017 at Indiana University Health University Hospital and who developed a VA-PSA were reviewed to assess incidence, presentation, treatment and outcomes. Read More

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http://dx.doi.org/10.1503/cjs.009519DOI Listing

Improved precision of radiographic measurements for distal radius fractures after a techniqueteaching tutorial.

Can J Surg 2020 May 21;63(3):E261-E271. Epub 2020 May 21.

From the Winnipeg Spine Program, Department of Surgery, University of Manitoba, Winnipeg, Man. (Fox); RebalanceMD, Victoria, B.C. (Johnston); and the Department of Community Health and Epidemiology, Dalhousie University, Halifax, N.S. (Stewart).

Background: For the management of distal radius fractures, surgical decision-making depends on radiographic measurements of indicators including radial inclination (RI), ulnar variance (UV) and radial tilt (RT). Evaluation of the inter- and intrarater reliability of surgeons' measurements of these criteria has been limited.

Methods: Twelve physicians were invited to participate in this study. Read More

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http://dx.doi.org/10.1503/cjs.001419DOI Listing

Humanistic education in surgery: a "patient as teacher" program for surgical clerkship.

Can J Surg 2020 May 13;63(3):E257-E260. Epub 2020 May 13.

From the Division of General Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ont. (Simpson, Ahmed, Rotstein); the Centre for Faculty Development, St. Michael's Hospital and University of Toronto, Toronto, Ont. (Ng); Applied Education Research Operatives, St. Michael's Hospital, Toronto, Ont. (Kangasjarvi); Department of Psychiatry, University of Toronto, Toronto, Ont. (Kalocsai); Academiec Affairs, St. Michael's Hospital, Toronto, Ont. (Hindle;) Women's College Hospital, University of Toronto, Toronto, Ont. (Kumagai); the University Health Network, University of Toronto, Toronto, Ont. (Cil); and Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ont. (Fenech).

Summary: Surgeons are frequently perceived by medical students to be uncompassionate, resolute and individualistic. Surgical education often prioritizes teaching and learning approaches that perpetuate these perceptions. In other specialties, engaging patients in education has shown promise in refocusing attention from the technical and procedural aspects of care toward the humanistic and social aspects. Read More

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http://dx.doi.org/10.1503/cjs.005319DOI Listing
May 2020
1.267 Impact Factor

Interventional radiology-assisted transgastric endoscopic drainage of peripancreatic fluid collections.

Can J Surg 2020 May 13;63(3):E254-E256. Epub 2020 May 13.

From the Division of General Surgery, Dalhousie University, Halifax, NS.

Summary: Peripancreatic fluid collections (PFCs) occur as a consequence of pancreatitis. Most PFCs resolve spontaneously, although 1%-2% persist and may require intervention. Conventional transluminal endoscopic drainage methods require the PFC to be bulging into the gastric wall; however, it is not uncommon for this to be absent. Read More

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http://dx.doi.org/10.1503/cjs.003019DOI Listing

The relationship between postoperative opioid consumption and the incidence of hypoxemic events following total hip arthroplasty: a post hoc analysis.

Can J Surg 2020 May 8;63(3):E250-E253. Epub 2020 May 8.

From Pfizer Inc., New York, NY (Essex, Pan, Cheung); the Department of Anesthesiology, University of Brussels, Brussels, Belgium (Camu); the Department of Anaesthesiology, Balgrist University Hospital, Zurich, Switzerland (Borgeat); and Pfizer Inc., Mexico City, Mexico (Salomon).

Background: Postoperative opioid analgesia may cause respiratory depression. We assessed whether following total hip arthroplasty, placebo-adjusted reductions in morphine consumption at 48 hours with parecoxib (47.0%), propacetamol (35. Read More

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http://dx.doi.org/10.1503/cjs.010519DOI Listing

Diagnosis and management of acute cholecystitis: a single-centre audit of guideline adherence and patient outcomes.

Can J Surg 2020 May 8;63(3):E241-E249. Epub 2020 May 8.

From the Department of Surgery, McMaster University, Hamilton, Ont. (Giles, Godzisz, Nenshi, Forbes, Farrokhyar, Lee, Eskicioglu); the Department of Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ont. (Nenshi, Eskicioglu); and the Department of Surgery, Hamilton Health Sciences, Hamilton, Ont. (Forbes).

Background: The Tokyo Guidelines were published in 2007 and updated in 2013 and 2018, with recommendations for the diagnosis and management of acute cholecystitis. We assessed guideline adherence at our academic centre and its impact on patient outcomes.

Methods: This is a retrospective chart review of patients with acute calculous cholecystitis who underwent cholecystectomy at our institution between November 2013 and March 2015. Read More

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http://dx.doi.org/10.1503/cjs.002719DOI Listing

Enhanced recovery after video-assisted thoracoscopic surgery lobectomy: a prospective, historically controlled, propensity-matched clinical study.

Can J Surg 2020 May 8;63(3):E233-E240. Epub 2020 May 8.

From the Division of Thoracic Surgery, Université de Montréal, Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman); and the CHUM Endoscopic Tracheobronchial and Oesophageal Centre (CETOC), Montreal, Que. (Tahiri, Goudie, Jouquan, Thiffault, Martin, Ferraro, Liberman).

Background: Enhanced recovery pathways or fast-tracking following surgery can decrease the rate of postoperative complications and hospital length of stay. The objectives of this study were to implement an enhanced recovery after surgery (ERAS) pathway for patients undergoing a video-assisted thoracoscopic surgery (VATS) lobectomy, to assess the safety and efficiency of this protocol by measuring associated postoperative outcomes, and to compare the outcomes for patients in the ERAS group with the outcomes for patients in a propensity-matched control group.

Methods: The study was a prospective clinical trial. Read More

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http://dx.doi.org/10.1503/cjs.001919DOI Listing

Postoperative fever in the time of COVID-19.

Can J Surg 2020 May 8;63(3):E231-E232. Epub 2020 May 8.

From the Department of Surgery, Division of Orthopaedic Surgery, University of Calgary, Calgary Alta. (Bourget-Murray, Bansal, Heard, Powell); and the Department of Medicine, Division of Infectious Diseases, University of Calgary, Calgary, Alta. (Johnson).

Summary: Postoperative fever is common following orthopedic trauma surgery. As the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection increases in the community, migration into the acute care hospital setting intensifies, creating confusion when fever develops postoperatively. The transmission dynamics of SARS-CoV-2 make it difficult to adequately gauge and pinpoint risk groups with questionnaires at the time of hospital admission. Read More

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http://dx.doi.org/10.1503/cjs.004720DOI Listing

Leadership proficiency in surgery: lessons from the COVID-19 pandemic.

Can J Surg 2020 05 8;63(3):E229-E230. Epub 2020 May 8.

From the Department of Surgery, University of Toronto, Toronto, Ont.

Summary: The coronavirus disease 2019 (COVID-19) pandemic has accentuated the importance of leadership training for health care professionals, particularly surgeons. Surgeons are expected to lead and thrive in multidisciplinary teams. There is, however, a critical gap in teaching residents about fundamental leadership principles, such as developing productive and vision-driven teams, conflict resolution and emotional intelligence. Read More

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http://dx.doi.org/10.1503/cjs.006020DOI Listing

Surgical wait list management in Canada during a pandemic: many challenges ahead.

Can J Surg 2020 05 8;63(3):E226-E228. Epub 2020 May 8.

From the Department of Surgery, St. Paul's Hospital, and the University of British Columbia, Vancouver, BC (Wiseman); the Department of Surgery, University of Calgary, Calgary, Alta. (Crump); and the Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, Vancouver, BC (Sutherland).

Summary: The coronavirus disease 2019 (COVID-19) pandemic has had a massive impact on waits for elective operations, with tens of thousands of scheduled surgeries being cancelled or postponed across Canada. Provincial governments will likely not only reopen elective surgical capacity when it is deemed safe, but also target new funding to address the backlog of cases. There is a dearth of research on whether the provinces' approaches to managing wait lists are equitable from a patients' needs perspective or if they are associated with patients' perception of outcomes. Read More

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http://dx.doi.org/10.1503/cjs.006620DOI Listing

Reducing time from colon cancer surgery to initiation of adjuvant chemotherapy: pilot project.

Can J Surg 2020 05 8;63(3):E223-E225. Epub 2020 May 8.

From the BC Cancer Vancouver Centre, Vancouver, BC (Melosky, Brown); the Hospital Alemão Oswaldo Cruz, São Paulo, Brazil (Peixoto); St. Paul's Hospital, Vancouver, BC (Karimuddin, Raval, Brown, Phang); the Department of Medicine, University of British Columbia, Vancouver, BC (Raval, Brown, Meneghetti, Phang); and the Vancouver General Hospital, Vancouver, BC (Meneghetti).

Summary: Surgical resection followed by adjuvant chemotherapy is the standard of care for patients with stage III colon cancer. To shorten the time interval between surgery and chemotherapy in patients with colon cancer, we instituted a standardized referral pathway. Evaluation of the intervention demonstrated that referring our patients with colon cancer to a medical oncologist earlier in the treatment process increased the number of patients in whom chemotherapy was initiated within 8 weeks compared with historical controls. Read More

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http://dx.doi.org/10.1503/cjs.000219DOI Listing

Morbidity and mortality conferences in general surgery: a narrative systematic review.

Can J Surg 2020 May 8;63(3):E211-E222. Epub 2020 May 8.

From the Department of Surgery, University of British Columbia, Vancouver, BC (Slater, Sekhon, Shariff, Chiu, Joos, Hameed); the Department of Surgery, University of Alberta, Edmonton, Alta. (Bradley); Quality and Patient Safety, Vancouver Coastal Health, Vancouver, BC (Bedford); Trauma Services, Kelowna General Hospital, Kelowna, BC (Wong); and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball).

Background: In medical and surgical departments around the world, morbidity and mortality conferences (MMC) serve dual roles: they are cornerstones of quality-improvement programs and provide timely opportunities for education within the urgent context of clinical care. Despite the widespread adoption of MMCs, adverse events and preventable errors remain high or incompletely characterized, and opportunities to learn from and adjust to these events are frequently lost. This review examines the published literature on strategies to improve surgical MMCs. Read More

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http://dx.doi.org/10.1503/cjs.009219DOI Listing
May 2020
1.267 Impact Factor

Distress in orthopedic trainees and attending surgeons: a Canadian national survey.

Can J Surg 2020 May 1;63(3):E190-E195. Epub 2020 May 1.

From the Royal Children's Hospital Melbourne, Parkville, Victoria, Australia.

Background: Physician health is of increasing concern in health care systems. The purpose of this study was to determine the prevalence of distress among orthopedic surgeons and trainees and to identify factors associated with distress.

Methods: Voluntary, anonymous online surveys were sent to attending orthopedic surgeons and orthopedic trainees across Canada. Read More

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http://dx.doi.org/10.1503/cjs.004319DOI Listing

The "teaching time-out": a novel framework for surgical education.

Can J Surg 2020 May 1;63(3):E208-E210. Epub 2020 May 1.

From the Division of General Surgery, University of Toronto, Toronto, Ont. (Guidolin, Quereshy); the Division of Neurosurgery, University of Toronto, Toronto, Ont. (Yan); and the Toronto Western Hospital, University Health Network, Toronto, Ont. (Quereshy).

Summary: In the decade since its inception, the World Health Organization's surgical safety checklist has fundamentally changed the conduct of surgery the world over. A critical component of the checklist - the "pause" or "time-out" - requires all operating room staff to stop other activities and together review critical information about the case to ensure that nothing is missed. Surgical trainees in Canada are transitioning to a competency-based medical education model; a core aspect of this model requires trainees to advocate for their own learning goals. Read More

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http://dx.doi.org/10.1503/cjs.005919DOI Listing

Total hip arthroplasty in patients with fibrous dysplasia: a modern update.

Can J Surg 2020 May 1;63(3):E202-E207. Epub 2020 May 1.

From the Division of Orthopaedic Surgery, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, Toronto, Ont.

Background: Fibrous dysplasia (FD) results from an abnormality in lamellar bone formation and most frequently involves the proximal femur. This can lead to the development of osteoarthritis requiring total hip arthroplasty (THA). Such cases are challenging, and there is a lack of information guiding best management. Read More

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http://dx.doi.org/10.1503/cjs.007219DOI Listing

Guided-motion hinged knee replacement prosthesis: early survival rate and postoperative patient function and satisfaction.

Can J Surg 2020 05 1;63(3):E196-E201. Epub 2020 May 1.

From the Department of Surgery, Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, Man. (Perrin, Turgeon); and the Concordia Joint Replacement Group, Concordia Hip & Knee Institute, Winnipeg, Man. (Turgeon).

Background: Literature on the survival rates and function of hinged total knee replacement (HTKR) prostheses is scarce, and to our knowledge there is not yet any published literature on the Legion HK Hinge Knee Replacement prosthesis (Smith & Nephew) with guided-motion articulation. The objective of this study was to establish the early survival rate of this modern HTKR at a single institution and to investigate postoperative patient function and satisfaction.

Methods: This retrospective study included patients who received the Legion HTKR prosthesis with guided-motion inserts as a primary or revision implant between October 11 and March 2016 at a tertiary care centre in Manitoba, Canada. Read More

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http://dx.doi.org/10.1503/cjs.002419DOI Listing

Guidance for management of cancer surgery during the COVID-19 pandemic.

Can J Surg 2020 05;63(22):S2-S4

From the Canadian Partnership Against Cancer (Finley, Prashad, Camuso, Daly, Earle); the Canadian Network of Surgical Associations for Cancer Care (Aprikian, Ball, Bentley, Charest, Fata, Helyer, O'Connell, Moloo, Seely, Werier, Zhong); the Canadian Urological Association and the Division of Urology, Department of Surgery, McGill University, Montreal, Que. (Aprikian); the Canadian Hepato-Pancreatico-Biliary Association and the Department of Surgery, University of Calgary, Calgary, Alta. (Ball); the Society for Gynecologic Oncology of Canada and the Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, NS (Bentley); the Canadian Neurosurgical Society and the Department of Neurosurgery, Dalhousie University New Brunswick, Moncton, NB (Charest); the Canadian Association of General Surgeons and the Division of General Surgery, Department of Surgery, McGill University, Montreal, Que. (Fata); the Canadian Society of Surgical Oncology and the Department of General Surgery, Dalhousie University, Halifax, NS (Helyer); the Canadian Association of Head and Neck Surgical Oncology and the Division of Otolaryngology - Head and Neck Surgery, University of Alberta, Edmonton, Alta.(O'Connell); the Canadian Society of Colon and Rectal Surgeons and the Division of General Surgery, Department of Surgery, University of Ottawa, and the Ottawa Hospital Research Institute, Ottawa, Ont. (Moloo); the Canadian Association of Thoracic Surgeons and the Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ont. (Seely); the Canadian Orthopaedic Oncology Society and the Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, Ottawa, Ont. (Werier); the Canadian Society of Plastic Surgeons and the Department of Surgery, University of Toronto, Toronto, Ont. (Zhong); the Department of Surgery, McMaster University, Hamilton, Ont. (Finley); the Department of Gastrointestinal Oncology, Sunnybrook Health Sciences Centre, Toronto, Ont. (Earle); and the Canadian Journal of Surgery (Ball).

Summary: During the coronavirus disease 2019 (COVID-19) pandemic, delaying lifesaving cancer surgeries must be done with extreme caution and thoughtfulness. Modelling indicates that delays in high-risk cancer surgeries beyond 6 weeks could affect long-term outcomes for thousands of Canadians. Consequently, it is possible that postponing cancer surgery without consideration of its implications could cost more lives than can be saved by diverting all surgical resources to COVID-19. Read More

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http://dx.doi.org/10.1503/cjs.005620DOI Listing

Lifesaving cancer surgeries need to be managed appropriately during the COVID-19 pandemic.

Can J Surg 2020 05;63(2):S1

From the Canadian Partnership Against Cancer (Finley, Prashad, Camuso, Daly, Earle).

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http://dx.doi.org/10.1503/cjs.005520DOI Listing

Does surgical approach influence mid- to long-term patient-reported outcomes after primary total hip replacement? A comparison of the 3 main surgical approaches.

Can J Surg 2020 Apr 17;63(22):E181-E189. Epub 2020 Apr 17.

From the Ottawa, Hospital, Ottawa, Ont. (Galmiche, Dobransky, Kim, Feibel, Gofton, Abdelbary, Beaulé); and the School of Rehabilitation, University of Ottawa, Ottawa, Ont. (Poitras).

Background: The most effective surgical approach to total hip replacement (THR) remains controversial. Most studies that have compared approaches have reported only short-term outcome data. It is therefore unclear in the literature if a particular surgical approach offers long-term advantages. Read More

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http://dx.doi.org/10.1503/cjs.008919DOI Listing

Factors that predict 30-day readmission after bariatric surgery: experience of a publicly funded Canadian centre.

Can J Surg 2020 Apr 17;63(2):E174-E180. Epub 2020 Apr 17.

From the Department of Surgery, University of Alberta, Edmonton, Alta. (Dang, Tavakoli, Switzer, Mocanu, de Gara, Birch, Karmali); and the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali).

Background: Hospital readmissions after bariatric surgery can significantly increase health care costs. Rates of readmission after bariatric surgery have ranged from 0.6% to 11. Read More

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http://dx.doi.org/10.1503/cjs.014918DOI Listing

One-stage versus 2-stage bilateral total joint arthroplasty: a matched cohort study.

Can J Surg 2020 Apr 17;63(2):E167-E173. Epub 2020 Apr 17.

From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Saini, Powell, Sharma, Puloski, Mahdavi, Johnston); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Smith).

Background: Patients with bilateral end-stage hip or knee arthritis want to know if it is safe to have bilateral surgery under a single anesthetic, to restore their quality of life as quickly as possible. The purpose of this study was to assess if there is an increase in the rate of postoperative medical adverse events, length of stay (LOS), blood transfusion rate and 30-day readmission rate among patients who undergo 1-stage bilateral total hip arthroplasty (BTHA) and 1-stage bilateral total knee arthroplasty (BTKA) compared with patients who undergo 2-stage BTHA and BTKA.

Methods: Our study cohorts included patients who underwent BTHA and BTKA between Apr. Read More

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http://dx.doi.org/10.1503/cjs.001019DOI Listing

COVID-19: a time of crisis, but also of surgical opportunity and optimism

Authors:
Chad G. Ball

Can J Surg 2020 04;63(2):E165

Corédacteur en chef, Journal canadien de chirurgie

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COVID-19: a time of crisis, but also of surgical opportunity and optimism

Authors:
Chad G. Ball

Can J Surg 2020 04;63(2):e164

Coeditor, Canadian Journal of Surgery

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Turning a new “page”: ways to decrease the number of pages after hours without compromising patient care

Can J Surg 2020 Mar 27;63(2):E155-E160. Epub 2020 Mar 27.

From the Department of Urology and Pediatric Urology, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany (Schröder); and the Department of Urology, Hospital for Sick Children, Toronto, Ont. (Farhat, Bägli, Lorenzo, Koyle).

Background: Pages to house staff after hours, especially overnight, lead to interrupted sleep and fatigue the next day. Although some pages are urgent, others may not need an immediate response. In this study we aimed to identify unwarranted pages and to establish ways to reduce them. Read More

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http://dx.doi.org/10.1503/cjs.009119DOI Listing

A 30-day prospective audit of all inpatient complications following acute care surgery: How well do we really perform?

Can J Surg 2020 Mar 27;63(2):E150-E154. Epub 2020 Mar 27.

From the Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alta. (Ball, Albusadi, Patterson, Kortbeek, MacLean); Western University, London, Ont. (Murphy, Parry, Vogt); the University of Alberta, Edmonton, Alta. (Verhoeff, Widder); the University of British Columbia, Vancouver, B.C. (Hameed); McMaster University, Hamilton, Ont. (Engels, Rice, Nenshi); McGill University, Montréal, Que. (Khwaja); and Dalhousie University, Halifax, N.S. (Minor).

Background: Acute care surgery (ACS) and emergency general surgery (EGS) services must provide timely care and intervention for patients who have some of the most challenging needs. Patients treated by ACS services are often critically ill and have both substantial comorbidities and poor physiologic reserve. Despite the widespread implemention of ACS/EGS services across North America, the true postoperative morbidity rates remain largely unknown. Read More

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http://dx.doi.org/10.1503/cjs.019118DOI Listing

Does body mass index affect the rate of adverse outcomes in total hip and knee arthroplasty? A retrospective review of a total joint replacement database

Can J Surg 2020 Mar 27;63(2):E142-E149. Epub 2020 Mar 27.

From the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Abdulla, Mahdavi, Gill, Powell, Johnston, Sharma); and the Alberta Bone and Joint Health Institute, Calgary, Alta. (Khong).

Background: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are reliable surgical options to treat pain and disability resulting from degenerative conditions around the hip and knee. Obesity is a modifiable risk factor that contributes to significant morbidity. The purpose of this study was to retrospectively compare outcomes in primary hip and knee arthroplasty for patients with increased body mass index (BMI) and those with normal BMI, using data from the registry of the Alberta Bone and Joint Health Institute (ABJHI). Read More

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http://dx.doi.org/10.1503/cjs.006719DOI Listing
March 2020
1.267 Impact Factor

Fidelity in surgical simulation: further lessons from the S.T.A.R.T.T. course

Can J Surg 2020 Mar 27;63(2):E161-E163. Epub 2020 Mar 27.

From the Department of Surgery, Section of General Surgery, University of Manitoba, Winnipeg, Man. (Johnson, Gillman); and the Department of Critical Care Medicine, Anesthesiology, University of Alberta, Edmonton, Alta. (Brindley).

Summary: Simulation has become a popular and ubiquitous medical education tool. In response to learner demands, and because of technological advancement, there is a trend toward increasing the realism of simulation. However, there is a paucity of evidence regarding what degree of fidelity is needed to deliver optimal simulation-based medical education. Read More

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http://dx.doi.org/10.1503/cjs.017818DOI Listing

Does exposure to anatomy education in medical school affect surgical residency applications? An analysis of Canadian residency match data

Can J Surg 2020 Mar 20;63(2):E129-E134. Epub 2020 Mar 20.

From the Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ont.

Background: The time dedicated to teaching gross anatomy, including cadaveric dissection, has been decreasing in North American medical schools. The impact of this trend on surgical residency applications is unknown. We sought to identify trends in surgical residency applications in Canada and to determine if medical schools with more gross anatomy instruction and mandatory cadaveric dissection produced more applicants ranking surgical residency programs as their first choice. Read More

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http://dx.doi.org/10.1503/cjs.019218DOI Listing

Idiopathic intracranial hypertension and bariatric surgery: a systematic review

Can J Surg 2020 03 20;63(2):E123-E128. Epub 2020 Mar 20.

From the Department of Surgery, Division of General Surgery, University of Alberta, Edmonton, Alta. (Sun, Switzer, Dang, de Gara, Birch, Karmali); the Department of Surgery, Division of General Surgery, University of Calgary, Calgary, Alta. (Gill); the Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alta. (Shi, de Gara, Birch, Karmali); and the Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alta. (Nataraj).

Background: Idiopathic intracranial hypertension (IIH) is a rare condition typically affecting women with obesity who are of child-bearing age. Patients commonly present with headaches, visual disturbances, pulsatile tinnitus and papilledema. The association between IIH and obesity has been well established in the literature, suggesting that weight loss may contribute to improving IIH. Read More

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http://dx.doi.org/10.1503/cjs.016616DOI Listing

Addressing organ shortages: progress in donation after circulatory death for liver transplantation

Can J Surg 2020 Mar 20;63(2):E135-E141. Epub 2020 Mar 20.

From the Department of Surgery, Division of General Surgery, University of Alberta Hospital, Edmonton, Alta. (Nostedt, Shapiro, Bigam); the Department of Physiology, University of Alberta, Edmonton, Alta. (Freed); and the Department of Surgery, Division of Cardiac Surgery, University of Alberta, Alberta Heart Institute, Edmonton, Alta. (Freed).

Reducing wait list mortality among patients awaiting liver transplantation remains a substantial challenge because of organ shortage. In efforts to expand the donor pool there has been a trend toward increased use of donation after circulatory death (DCD) liver grafts. However, these marginal grafts are prone to higher complication rates, particularly biliary complications. Read More

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http://dx.doi.org/10.1503/cjs.005519DOI Listing

The next step in surgical quality improvement: outcome situational awareness

Can J Surg 2020 Mar 13;63(2):E120-E122. Epub 2020 Mar 13.

From the Department of Surgery, Carolinas Medical Center, Charlotte, NC (Lyman, Matthews); and the Division of HPB Surgery, Carolinas Medical Center, Charlotte, NC (Passeri, Murphy, Cochran, Iannitti, Martinie, Baker, Vrochides).

Summary: A similar theme unites proposed solutions for stagnant improvement in outcomes and rising health care costs: eliminate unnecessary variation in the care of surgical patients. While large quality-improvement projects like the Americal College of Surgeons National Surgical Quality Improvement Program have historically led to improved patient outcomes at the hospital level, the next step in surgical quality improvement is to eliminate unnecessary variation at the level of the individual surgeon. Critical examination of individualized clinical, financial and patient-reported outcomes — outcome situational awareness — along with peer group comparison will help surgeons to identify variation in patient care. Read More

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http://dx.doi.org/10.1503/cjs.000519DOI Listing

Heroes, citizens, and the shoulders of giants

Authors:
David R. Urbach

Can J Surg 2020 Mar 6;63(2):E118-E119. Epub 2020 Mar 6.

Summary: Is the hero role the best self-image for surgeons in the modern world? As Donald Berwick, founder of the Institute for Healthcare Improvement, has pointed out, health care is an exercise in interdependency, not personal heroism. In my president’s address to the Canadian Association of General Surgeons, I examine the role of the surgeon as hero and citizen. Read More

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http://dx.doi.org/10.1503/cjs.018419DOI Listing

Development of a certification examination for orthopedic sports medicine fellows

Can J Surg 2020 Mar 6;63(2):E110-E117. Epub 2020 Mar 6.

From Mount Sinai Hospital, Toronto, Ont. (Dwyer, Theodoropoulos); Toronto Western Hospital, Toronto, Ont. (Chahal, Ogilvie-Harris); and Women’s College Hospital, Toronto, Ont. (Dwyer, Chahal, Murnaghan, Theodoropoulos, Cheung, McParland, Ogilvie-Harris).

Background: The purpose of this study was to develop a multifaceted examination to assess the competence of fellows following completion of a sports medicine fellowship.

Methods: Orthopedic sports medicine fellows over 2 academic years were invited to participate in the study. Clinical skills were evaluated with objective structured clinical examinations, multiple-choice question examinations, an in-training evaluation report and a surgical logbook. Read More

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http://dx.doi.org/10.1503/cjs.015418DOI Listing

Unwarranted imaging for distant metastases in patients with newly diagnosed ductal carcinoma in situ and stage I and II breast cancer

Can J Surg 2020 02 28;63(2):E100-E109. Epub 2020 Feb 28.

From the Tom Baker Cancer Centre, Calgary, Alta. (Lupichuk); CancerControl Alberta, Alberta Health Services, Calgary, Alta. (Tilley, Surgeoner); and the Cross Cancer Institute, Edmonton, Alta. (King, Joy).

Background: In 2012, the American Society of Clinical Oncology (ASCO) released a Choosing Wisely Top Five list that included a recommendation against ordering advanced imaging tests to screen for metastases among asymptomatic patients with early breast cancer. Our provincial breast cancer staging guideline was subsequently updated. We report on the use of unwarranted bone scanning (BS), computed tomography (CT), nonbreast magnetic resonance imaging (MRI) and positron emission tomography (PET) among women diagnosed with stage 0–II breast cancer in Alberta in 2011–2015. Read More

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http://dx.doi.org/10.1503/cjs.003519DOI Listing
February 2020

The surgeon’s perspective: a retrospective study of wide local excisions taken to healthy subcutaneous fat in the management of advanced hidradenitis suppurativa

Can J Surg 2020 Feb 28;63(2):E94-E99. Epub 2020 Feb 28.

From the Department of Medicine, Women’s College Hospital, and the Department of Surgery, CIBC Breast Centre, St. Michael’s Hospital, University of Toronto, Toronto, Ont.

Background: Hidradenitis suppurativa (HS) is a chronic debilitating folliculopilosebaceous disease that affects the skin most commonly in the axilla, groin, inframammary, genital and buttock areas. Surgical intervention may be an appropriate option in selected cases, but there is a risk of recurrence. The purpose of this study was to assess the results of wide local excision (WLE) to healthy subcutaneous fat with secondary intention healing in patients with HS who were under concurrent surgical and dermatologic care. Read More

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http://dx.doi.org/10.1503/cjs.003119DOI Listing
February 2020

Leveraging vascular quality initiative data to improve hospital length of stay for patients undergoing endovascular aneurysm repair

Can J Surg 2020 Feb 28;63(2):E88-E93. Epub 2020 Feb 28.

From the Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ont. (Eisenberg, Roche-Nagle, Lindsay, Oreopoulos); the Faculty of Medicine, University of Toronto, Toronto, Ont. (Roche-Nagle, Lindsay, Oreopoulos); and the Division of Vascular Interventional Radiology, Peter Munk Cardiac Centre, University Health Network, Toronto, Ont. (Roche-Nagle, Oreopoulos).

Background: The Society for Vascular Surgery Vascular Quality Initiative (SVS-SVQI) is a database that provides insight into standards of care and highlights opportunities for quality improvement by benchmarking institutional data against local, regional and national trends. Endovascular aneurysm repair (EVAR) is a frequently performed vascular operation. Postoperative length of stay in hospital (LOS) varies among institutions. Read More

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http://dx.doi.org/10.1503/cjs.003219DOI Listing
February 2020

Venous thromboembolism in emergency general surgery patients: a single-centre retrospective cohort study

Can J Surg 2020 Feb 26;63(1):E80-E85. Epub 2020 Feb 26.

From the Division of General Surgery, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Yang, Murphy, Sela, Govind, Leslie, Vogt); and the London Health Sciences Centre, London, Ont. (Allen).

Background: There is limited literature on the risk of venous thromboembolism (VTE) in emergency general surgery (EGS) patients. We undertook this study to identify the rate of symptomatic VTE for patients undergoing EGS operations.

Methods: We conducted a retrospective cohort study evaluating EGS patients who underwent operative intervention between March and December 2014. Read More

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http://dx.doi.org/10.1503/cjs.006318DOI Listing
February 2020

Peut-on se fier aux niveaux de preuve pour prendre des décisions?

Authors:
Edward Harvey

Can J Surg 2020 Feb 26;63(1):E87. Epub 2020 Feb 26.

Corédacteur en chef, Journal canadien de chirurgie

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http://dx.doi.org/10.1503/cjs.002520DOI Listing
February 2020

Can we use levels of evidence to make a decision?

Authors:
Edward Harvey

Can J Surg 2020 Feb 26;63(1):E86. Epub 2020 Feb 26.

Coeditor, Canadian Journal of Surgery

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http://dx.doi.org/10.1503/cjs.001920DOI Listing
February 2020

Evaluation of repeat cytoreductive surgery and heated intraperitoneal chemotherapy for patients with recurrent peritoneal carcinomatosis from appendiceal and colorectal cancers: a multicentre Canadian study

Can J Surg 2020 Feb 21;63(1):E71-E79. Epub 2020 Feb 21.

From the Department of Surgery, Foothills Medical Centre, University of Calgary, Calgary, Alta. (Jost, Mack, Temple, Bouchard-Fortier); and the Department of Surgery, Maisonneuve-Rosemont Hospital, Université de Montréal, Montréal, Que. (Sideris, Dube).

Background: Peritoneal recurrences after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) for appendiceal and colorectal cancers are frequent. This study aimed to evaluate the safety, technical feasibility and perioperative and long-term outcomes of repeat CRS/HIPEC in patients with recurrent peritoneal carcinomatosis of colorectal and appendiceal origin.

Methods: Data were collected from patients treated from 2000 to 2016 for recurrent peritoneal carcinomatosis from appendiceal or colorectal cancer with CRS/HIPEC at 2 specialist centres. Read More

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http://dx.doi.org/10.1503/cjs.002519DOI Listing
February 2020

Older patients with differentiated thyroid cancer exhibit more aggressive pathological characteristics than younger patients

Can J Surg 2020 Feb 7;63(1):E69-E70. Epub 2020 Feb 7.

From the Department of Surgery St. Paul’s Hospital & University of British Columbia, Vancouver, BC.

Summary: Differentiated thyroid cancer (DTC) has long been recognized as having a worse prognosis in older people. We retrospectively evaluated the clinical and pathological characteristics of 973 sequentially treated patients with primary DTC stratified into 2 age groups, ≥ 55 or < 55 years, based on the current American Joint Committee on Cancer (AJCC) DTC staging system. We found that older patients had a higher frequency of extrathyroidal cancer extension and larger cancers, and that their cancers were less commonly completely resectable. Read More

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http://dx.doi.org/10.1503/cjs.017918DOI Listing
February 2020

A novel online education module to teach clinicians how to correctly identify ultrasonographic features of mediastinal lymph nodes during endobronchial ultrasound

Can J Surg 2020 Feb 7;63(1):E62-E68. Epub 2020 Feb 7.

From the Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Hylton, Fahim, Hanna); and the Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ont. (Shargall, Agzarian, Hanna).

Background: Ultrasonographic features can be used to predict mediastinal lymph node malignancy during endobronchial ultrasonography. Despite the validity of using these features for this purpose, the features are not being widely used in clinical practice. This may be attributable to the absence of educational programs that teach clinicians how to identify the features. Read More

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http://dx.doi.org/10.1503/cjs.000119DOI Listing
February 2020

Evaluating the utility of computed tomography of the chest for gastric cancer staging

Can J Surg 2020 Feb 7;63(1):E57-E61. Epub 2020 Feb 7.

From the Department of Surgery, University of Alberta, Edmonton, Alta. (Nostedt, McCall, Schiller); the Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta. (Gibson-Brokop); the Department of Medical Oncology and the Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alta. (Ghosh); and the Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alta. (Seidler).

Background: International guidelines recommend routine computed tomography (CT) of the chest for gastric cancer staging. In Asian countries, where the incidence of pulmonary metastases is less than 1%, some guidelines recommend chest CT only for gastroesophageal junction cancers. If the incidence of pulmonary metastases is also low in Canada, routine chest CT may not be beneficial. Read More

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http://dx.doi.org/10.1503/cjs.000319DOI Listing
February 2020

The economic impact of periprosthetic infection in total hip arthroplasty

Can J Surg 2020 Jan 29;63(1):E52-E56. Epub 2020 Jan 29.

From the Division of Orthopaedic Surgery, Department of Surgery, Western University, London, Ont. (Akindolire, Morcos, Marsh, Howard, Lanting, Vasarhelyi); and the Division of Orthopaedic Surgery, London Health Sciences Centre, London, Ont. (Akindolire, Morcos, Howard, Lanting, Vasarhelyi).

Background: Periprosthetic joint infection (PJI) is the third leading cause of total hip arthroplasty (THA) failure. Although controversial, 2-stage revision remains the gold standard treatment for PJI in most situations. To date, there have been few studies describing the economic impact of PJI in today’s health care environment. Read More

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http://dx.doi.org/10.1503/cjs.004219DOI Listing
January 2020